Today’s Fight Over Vaccines is Not Over Yet

Today’s Fight Over Vaccines is Not Over Yet

Recently, the state of California passed a law that requires almost all California school children to be fully vaccinated in order to attend public or private school, regardless of their parents’ personal or religious beliefs. California now joins only two other states — Mississippi and West Virginia — that permit only medical exemptions as legitimate reasons to sidestep vaccinations.

Many people who opposed the law began to debate “personal liberties,” and “personal freedoms,” as anti-vaccination groups began to scheme about how to take down the law. Debates over public health and personal liberty can seem utterly of the moment in response to new and evolving threats, but a flashback to our nascent nation in the summer of 1776 — when liberty was pretty much the topic of the day — can reveal just how long the debate over government health policies has been running, and how the meaning of “freedom” has changed when it comes to access to preventive medicine.

In Boston, the first Independence Day was preceded by inoculation day, when the Massachusetts general court abolished a ban on inoculating people against small pox. Only people who wanted to be inoculated or had already had the disease were allowed in the city. To leave the city before the inoculation period had ended, people needed the permission of a doctor or judge.

Two years earlier, 20 men in Marblehead brought torches and tar to burn down a new hospital — not because of corporate fascists who were forcing them to get vaccines, but to protest the high-cost system that was shutting the poor out from access to small pox inoculations. Hannah Winthrop, the wife of Harvard mathematics professor John Winthrop, described the scene: “Boston has given up its Fears of an invasion & is busily employd in Communicating the Infection. … Men Women & children eagerly crowding to inoculate is I think as modish as running away from the Troops of a barbarous George was the last year.”

But strict laws such as California’s can seem to some like an authoritarian scheme that threatens carefully guarded personal liberties. Even public health experts who unequivocally think that vaccination needs to be more widespread are unsure whether despite good intentions, the new law could backfire and have the unintended consequence of strengthening the anti-vaccination movement. If anything, history teaches us that debates over public health and liberty predate government as we know it and are likely to rage on — although no one expects any hospitals to be burnt down in 2015.

Instead of mandatory vaccinations, U.S. medicine has largely been guided by an idea traced to an influential medical textbook called Domestic Medicine, in which public health policies help reinforce “custom, which was the strongest of all laws. If you didn’t vaccinate, there would be enough pressure on you. Ostracism from the community would be enough.”

At the least, the situation in California might be seen as an experiment — when custom breaks down and outbreaks occur, what is the best solution? Will a strict new law mean more children will be vaccinated and measles declines, or will the anti-vaccine movement gain strength?